Genitourinary Flashcards
Gold standard investigation for suspected renal colic
Non-contrast CT Kidney, Ureter, Bladder
1L = X-ray KUB
Investigation for suspected renal colic if pregnant
Abdominal Ultrasound
Why do we not want to use contrast very often?
Contrast raises risk of anaphylactic reactions
Tamsulosin uses and pharmacology
Uses: BPH tx
A1-Adrenergic Antagonist
Blocks A1a and A1b receptors in the prostate > smooth muscle relaxation > better urine flow
Acts on GU AND vessel smooth muscle :. can cause low BP
What is the difference between alpha and beta adrenergic receptors
Alpha: stimulate effector cells - vasoconstrict
smooth muscle
Beta: relax effector cells - vasodilate smooth + cardiac muscle
Physiology + presentations of Nephritic Syndrome
Damaged glom. more permeable > protein from blood into nephron > PROTEINURIA
Albumin leaves blood > HYPOALBUMINAEMIA
Oncotic pressure falls (less protein in blood) > lowers osmotic pressure > water moves out of vessels into tissue > OEDEMA
Loss of protein > less lipid synthesis > more lipid remains in blood > HYPERLIPIDAEMIA, LIPIDURIA
What are we shitting our pants about when someone develops AKI
Hyperkalaemia
Bad kidney > can’t excrete K+ > hyperK > cardiac arrest
GFR Staging
*ml/min
1 : >90 + renal damage 2: 60-89 + renal damage 3a: 45-59 +/- renal damage 3b: 30-44 +/- renal damage 4: 15-29 +/- renal damage Stage 5: <15 = renal failure
Pt presents feeling nauseous with fatigue, pruritus, appetite-loss and restless legs, You note peripheral oedema and bloods show anaemia.
Likely diagnosis?
Chronic Kidney Disease
(Less EPO > Anaemia)
(Urea builds > n/v, metal-mouth, pruritus)
Pt presents with a abdominal lump and haematuria. They have a history of Hypertension and smoke.
Imaging shows Renal cysts. Likely diagnosis?
Polycystic Kidney disease
Pt presents with ^^oliguria, and a sharp creatinine rise.
Likely diagnosis? What electrolyte should you be worried of? What drug is contraindicated?
Acute Kidney Injury
Worry about Hyperkalaemia - tall T-waves
Dopamine contraindicated
Common causes of UTI?
KEEPS
Klebsiella - 10% E coli - 80% Enterococcus Proteus mirabilis - 5% S saphrophyticus - 5%
Pt presents with dysuria and nocturia. Their wee is cloudy.
Likely cause?
UTI
Pt presents with haematuria, flank pain and an abdominal mass.
Genetic tests reveal a mutation in Chromosome 3.
Likely diagnosis?
Von Hippel Lindau = malignant cancer of the PCT Epithelium
What is the most common abdominal malignancy in children?
Wilms’ Tumour = Nephroblastoma
Primitive renal tubes + mesenchymal cells
GOLD surgical Management for BPH
TURP
Gold medical management for BPH
2L management
alpha-blocker - Tamulosin, Doxazosin
5-a-reductase inhibitor
2L: Finasteride (hair)
Pt presents with severe intermittent abdominal pain. The pain is felt on their right side and testicles.
Upon going to the toilet, they noticed red urine. Pt is apyrexial.
Likely diagnosis?
Investigations?
KIDNEY STONES
- side -> testicles (loin to groin)
GOLD: Non-contrast CT KUB
Pt presents with painless haematuria. He works in a cloth-dying factory.
Likely diagnosis? RF? Investigations? Management?
Bladder Cancer - Transitional Cell Carcinoma
Investigations:
1L: Flexible cystoscopy
GOLD: CT Urogram
Management: TURBT
Transurethral Resection of Bladder Tumour
+ Mitomycin C Chemo
+ BCG immunotherapy (non-muscle invasive)
Types of bladder cancer
Transitional Cell Carcinoma
Squamous Cell Carcinoma
Adenocarcinoma
Small Cell Bladder Cancer
Risk factors for Transitional Cell Carcinoma (bladder)
- SMOKING
- Aromatic amines (rubber, dyes)
- Cyclophosphamide
TCC SAC
Risk factors for Squamous cell carcinoma (bladder)
- Schistosomiasis infection
- Long-term catheter (10+ yr)
Risk factors for Adenocarcinomas (bladder)
- Local bowel cancer
- Other bladder cancers
Risk factors for Small cell carcinomas (bladder)
- Other bladder cancers
